Question: At our facility, the CS staff insists on hand-washing all instruments before they are put into the washer/disinfector because they say if they don't, the instruments don't get clean. I have found several articles related to both manual cleaning and mechanical cleaning but I can't find the source. Can you help? Do you have any other sources that could help clear this up? I don't think it is necessary to do both. -- EU,
Answer: I know that mechanical washer manufacturers pride themselves on saying that the machine negates the need to pre-clean. I will not argue the claim. However, I will give you the standard that has been put into place to protect all patients and to protect from something called biofilm. The standard of practice is: Pre-clean, sonic if you have one (most facilities do), then either wash rinse dry or place into a mechanical washer or washer sterilizer (make sure your solutions are EPA-approved and compatible with your facilitys water source and the proper use of enzymatics can enhance your cleaning process). I have said it before and will say it again: skipping steps can kill. Despite the claims of manufacturers of mechanical washing devices, to which I will not argue, I strongly encourage you to adhere to the time-tested and true standard of practice for CS processing. If you or your staff are not certified or have not at least gone through a CS-accredited course, I encourage you to do so via a few sources but one good one can be found at www.iahcsmm.org. This organization has an online and extended study program that you can challenge. I strongly suggest that all your staff attend and/or go through this course that covers standards of practice for CS. I applaud your staff which has kept true to practice and insist on pre-cleaning despite the contrary belief that mechanical machines can do the entire job. Many can do a great job but nothing replaces observation, pre-cleaning or soaking, sonic, and rinse dry or mechanical cleaning if your facility has a mechanical washer or washer sterilizer. Not holding to the standard can indeed present problems, potential misses of bioload or the formation of biofilm in lumens or hard-to-clean crevices. See the article I wrote on bioload and biofilm formation on the ICT Web site. I know why there is pressure to skip steps in the OR but we must remember that our job is one of patient safety, not personnel convenience. In order to hold to a positive and progressive infection control plan that not only minimizes risk but can, if followed, eradicate most risk of infection, from what we choose to use to how we choose to use it and how we choose to re-use it. I thank you for your question and applaud you for seeking the answer you need to continue protecting your patients! Kudos to your staff! You have a good team with a patient focus!